In Part 1, Dr. Kim presented information about the historical and legal background for cannabis, variations in policies in the states, and the status of current research. In Part 2, she discussed cancer pain that is not neuropathic. She described the results of a study that involved opioid refractory cancer pain. Evidence currently shows that patients who have increased access to cannabis actually have higher rates of opioid overdose and deaths. She reviewed a case of one of her patients who had prostate cancer. This individual was not amenable to physical therapy and was weaned off opioids because they were not effective. Finally, they decided to try different types of cannabis for pain and sleep and he is doing quite well. He eventually used a combination of low and high THC capsules and was weaned off all other drugs. She and her colleagues also looked at how patients considered the use of cannabinoid therapy and found that overall they preferred it for their future chemo. Even though cannabis is a natural product, it is not true that it is free of side effects. There is some concern that it can have interactions on the heart, result in psychotic symptoms, affect psychomotor performance, and lead to an increase in tolerance, making it necessary to use higher and higher doses to achieve the same effect. A question-and-answer period followed her presentation.
In Part 1 of a two-segment presentation, Dr. Kim discussed historical and legal background for medical cannabis and cannabis in general; mechanism of action; applications for pain and symptom management; the science behind cannabis for cancer care; relative safety issues; contraindications and monitoring; and some public health concerns. She defined cannabis, marijuana, hemp, and indicated various code names for recreational marijuana. Marijuana was criminalized and removed from the U.S. Pharmacopeia in 1941, Most recently, some states have legalized it both medically and recreationally. For medical purposes, there is a lot of variation in what states will allow. A concern has been about the presence of contaminants in many products. Based on current research, the science and the evidence are not where they could be ideally. She discussed marijuana and how it works, mentioning the endocannabinoid system. Different ways exist to act on that system. She described the entourage effect and how it functions.
Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology.
In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s. Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS).
In Part 2 of his presentation, he continued describing the current state of research on the use of PNS, which to some degree is lacking, but certainly it potentially is increasing. He referred to a multi-center, randomized, double-blind investigation that looked at PNS technologies in a variety of pain conditions. He then described a product that was cleared by the FDA in July 2016. It involves the use of multiple electronic leads rather than using a single one. The implant used is of a temporary nature (60 days) rather than something permanently. He pointed out that because the technology is much smaller, no incision is necessary. The micro lead is much smaller in diameter and does not have to be as close to the nerve. He showed a video about a typical implant for a shoulder, involving the 60-day version of technology being used. While it played, he narrated some of the steps shown in the video regarding the implant of the electrode. Everything becomes stabilized as the electrode moves closer to the nerve. His presentation concluded with his fielding questions asked by participants at this event, including two by Dr. Steven Flanagan, Director of the Rusk Rehabilitation Institute at NYU Langone Health.